Sleep: A to Zzzzzzzzzz

Take a look at the results from the Heart Scan Blog's most recent reader poll (399 respondents):

How many hours do you sleep per night (on average)?


9 or more hours per night
15 (3.7%)

8-9 hours per night
72 (18%)

7-8 hours per night
152 (38.1%)

6-7 hours per night
111 (27.8%)

5-6 hours per night
38 (9.5%)

Less than 5 hours per night
11 (2.8%)


Like many issues in health, too much or too little of a good thing can present undesirable consequences.

Too much sleep: While psychologists and sleep researchers advise us that at least 9 hours are required to fully eliminate sleep "debt" and achieve optimal vigilance and mental performance, epidemiologic studies have shown increased mortality with this quantity of sleep.

Too little sleep: Getting less than 7 hours habituallly increases blood sugar, appetite, inflammatory measures, and encourages weight gain. Mortality is also increased, just as with sleeping too much. It is also associated with increased likelihood of a positive heart scan score.

7-8 hours per night from a health viewpoint is that Goldlilocks "just right" value: just enough to not erode mental performance substantially, but not so little that inflammatory, insulin-disrupting, and appetite-increasing effects develop.

Of our 399 respondents in the poll, 56.1% (38% + 18%) slept what appears to be an optimal amount for health. While only 3.7% slept too much (9 hours or more), the remaining 40.1% slept too little.

Our informal poll confirms what most of us observe in everyday life: The majority of people shortchange sleep in order to meet the demands of their high-pressure, squeeze-as-much-as-possible-into-every-day lives. But not paying off your sleep "debt" is like not paying the mortgage for a couple of months. You wouldn't expect your friendly neighborhood bank to say, "Oh, you forgot to pay your mortgage? Forget about it. Just pay next month's." Sure, fat chance. But if you don't pay off your sleep "debt," you will pay it back with health.

Comments (5) -

  • Anonymous

    6/23/2009 7:30:43 PM |

    Some thoughts I have about the causality vs. correlation. Those studies that show correlation with increased mortality /disease with sleep times longer than 9 hours per day could suggest that people with deseases sleep longer because of the disease?  Not that longer sleep periods them selfs are the cause of the disease and early death but a sign of troubles in health which need more time for the body to trying to recuperate?

    I personally sleep between  7 - 9 hour per day if I can rest up to my taste, but if I'm stressed I sleep less and if I'm sick I sleep more.

    (Sorry for possible spelling mistakes, I'm not native english speaker.)

    WBR:
    JVAS

  • Dr. William Davis

    6/23/2009 7:40:51 PM |

    Anon--

    Excellent point.

    In fact, I wonder if greater sleep need is, for many, a red flag for hypothyroidism, in addition to other conditions.

  • kris

    6/24/2009 2:04:35 PM |

    Brain study shows differences in night owls, early risers
    Last Updated: Tuesday, June 23, 2009 | 5:36 PM MT  
    CBC News  

    Scientists at the University of Alberta have found there are significant differences in the way our brains function, depending on whether we are early risers or night owls.

    Using magnetic resonance imaging-guided brain stimulation, neuroscientists tested muscle torque and the excitability of pathways through the spinal cord and brain.

    "We found that the brains of morning people are more excitable in the morning and evening people are completely opposite," neurophysiology researcher David Collins said Tuesday.

    "The evening people ... it's almost a perfect storm of excitability in the central nervous system, where the brain is maximal in the evening and the spinal cord is maximal in the evening.... They generate the most force in the evenings," he said.

    David Collins, neurophysiology researcher at the University of Alberta (CBC) "Morning people ... their brains are most excitable in the morning, but their spinal cords are most excitable in the evening," Collins said.  

    The results may suggest that morning people are performing below their maximum possible level at all times of the day because of this, he said.
    Morning person may be steadier

    If you could change morning people into evening people, maybe their performance would be best in the evening, he suggested. This doesn't mean it's necessarily better to be an evening person, he said.

    "A morning person may be a more consistent, steady plodder over the course of the day," Collins said.

    Kaitlin Cleveley, a sports performance researcher at the U of A, likes to begin work around 10 p.m. and go until 3 a.m.

    "Anything that starts in the morning is absolutely brutal for me to try and get up and try and function," she said. This study brings new perspective to training, she said.

    "It's about trying to peak the athlete.... It can help to set up a sleep program, and it can help to reduce jet lag and sort of help you to determine you know 'When should I book the flight?, When should I get there?'" Cleveley said.

    The research has lots of applications, including understanding mental and physical peaks and how people can maximize performance, she said.

    Initially the research was to determine if brain function changes over the day, Collins said.

    The study evolved with some early findings around two subjects in the study. One proved to be an extreme morning person, the other an extreme evening person, he said.

  • Anonymous

    6/27/2009 12:15:28 AM |

    How does napping fit into this?  Does napping count in the "hours per night" or is it separate?  Any statistics on mortality and napping?

    A lot of cultures have an afternoon siesta but Americans tend to frown on napping.

  • Anna

    6/29/2009 6:43:05 PM |

    A close family member just underwent double bypass surgery in the past few weeks (doing well now, though it took a blood transfusion to get over a 2 day slump while in the hospital), after more than a year of symptoms with exertion,  poor stress test results, a lot of career stress recently, etc.  None of us were told though until just before the recent angiogram.   I always viewed this situation as a "when", not an "if", because I had a different view than the AHA's, but it's always "too soon", even if expected.

    The angiogram revealed multiple sites of stenosis in locations not suitable for stents, so double bypass was performed.

    Aside from family history (her father died of CVD at age 50), there were other risk factors, so she faithfully followed most of the AHA guidelines since at least the 80s - regular chol panels (high results), statins, HRT, low fat/high chol, reduced saturated fat, reduced fat dairy, lean meats, lots o' carbs (even lots of whole grains), etc.  

    But obviously, this didn't work (I think it's a recipe for a bypass), because  CVD happened anyway despite all this adherence to  "prevention" (I use that word loosely in this context).  

    Other risk factors include tendency toward "apple" shape, "strong explosive" personality (sort of Type A), and as I suspected, diabetes (though that was concealed from the family until just before the surgery).  On top of that ...(drum roll)...

    and pertinent to this post - 25+ years of working the third shift as a nurse in L & D.  She was *chronically* and noticeably sleep-deficient (very often apparent, even over the phone), not to mention also Vitamin D deficient (her calcium supplement only added a tiny amount).  The coronary calcium scan wasn't done until last year, when there was marked plaque and shortness of breath & fatigue symptoms.  Of course no program such as Track Your Plaque was suggested or undertaken.  It was fate, right? - the family history - nothing could be done to override that, right? Note: if you are reading this with a sarcastic tone, that's about right Wink.

    Talk about an AHA failure to prevent. Everything I've  I shared about about the AHA's misguided approach to prevention, low carb and grain restriction to manage BG and diabetes, and all the other ways to prevent CVD fell on deaf ears.  Still does.  Still keeping my fingers crossed that the bypass arteries don't clog up.

Loading
But fish oil is too drastic!

But fish oil is too drastic!

Ted is a 74-year old physician, still conducting a busy practice. He came to me because of some vague fatigue and breathlessness. He also got himself a CT heart scan. His score: 1277.

When he came to my office, he clearly became breathless with just minimal effort. A stress test confirmed an area of much reduced blood flow to the front of his heart muscle. A heart catheterization identified a severe blockage of 95% in the left anterior descending artery and a stent was inserted. This resulted in relief of Ted's symptoms.

When Ted returned to the office after his discharge from the hospital, I advised him that some major changes in his prevention program were overdue. "After all, Ted, you were lucky this time. You were provided some warning. It doesn't always work that way." So I advised Ted to make a number of changes in his diet (he was following an old-fashioned, and quite self-destructive, low-fat diet), have lipoproteins assessed to identify hidden causes of coronary plaque, and take fish oil.

"Fish oil? I don't think so. That's pretty drastic!" he exclaimed. He felt that all the nutrition he needed was contained in the food he ate. Even after several lipoprotein abnormalities were uncovered like small LDL and excessive after-eating (post-prandial) patterns, he still resisted any changes. "I'm going to just wait and see how I feel. But I will take aspirin."

Such is the state of mind of the older physician: procedures are okay, low-fat diets prevent heart disease, and the Beatles are touring America. But fish oil? No way!

Unfortunately, Ted's attitude encapsulates the attitudes of many of my medical colleagues who don't share the excuse of age. They still practice the woefully outdated ways of physicians like Ted, clinging to notions of "balanced diets", nitroglycerin representing a rational treatment for coronary disease, and adequate rest being curative for heart conditions.

The world is changing. We're entering an exciting age of self-empowerment. The ridiculous notions of health practiced in the last half of the 20th century are withering and dying. Poor Ted. He must view the current healthcare landscape as increasingly incomprehensible to a guy who started out delivering babies at home. Perhaps, in some respects his world was better. But, in coronary disease prevention, attitudes like this need to go the way of steam engines and racial segregation--good riddens!
Loading
In search of wheat: Another einkorn experience

In search of wheat: Another einkorn experience

Lisa is a trained dietitian. Unlike many of her colleagues, she has "seen the light" and realized that the conventional advice that most dietitians are forced to dispense through hospitals, clinics, and other facilities is just plain wrong

I know Lisa personally and we've had some great conversations on diet and nutritional supplements. I told Lisa about my einkorn experience and how I witnessed a dramatic difference between bread made from einkorn wheat and that made from conventional whole wheat. So she decided to give it a try herself. 

Here's Lisa's experience:


This past Friday, June 18th, I conducted my "Einkorn Wheat Experiment".

7 am 
FBG [fasting blood glucose] 97 mg/dl

8 am-9 am 
1 hour high-intensity aerobic workout

10:05 am 
BG 99

10:05 am 
I embarked upon the journey of choking down, I mean enjoying, the hefty piece of Einkorn bread. Wow, was that bread dense!  It was a lot of work chewing. 

10:50 am 
(45 minutes after consumption, wanted to see what BG did a bit before the 1 hr mark)  BG 153

11:05 am 
1hr PP 120

11:35 am 
90 mins PP [postprandial] 113

12:05 pm 
2 hours PP  114 ... at this time I ate an egg & veggie omelet for lunch.

12:50 pm 
BG 100

Before dinner 5:10 pm 
BG 88

I was surprised with the BG of 153. However, it was good to see my insulin response is reactive and decreased BG 33 points in 15 minutes to end up with a BG of 120 1 hr after the bread.  

So, it appears my response is similar. A slight elevation of BG at the 1 hour mark, but not to the degree of conventional whole grain wheat bread.  

Of note, also, was the fact that I cannot remember the last time I ate a piece of wheat bread of this magnitude that did not make me bloated... not at all: No cramps, no brain fog, no headache and, did I mention not bloated?  

I believe you are on to something with tolerance of Einkorn wheat for those of us with wheat sensitivities, in addition to its apparent lower glycemic response.

Along with Lisa, I asked four other people with various acute intolerances (all gastrointestinal) to conventional wheat, i.e., people who experience undesirable effects from wheat within minutes to several hours, to eat the einkorn bread. None experienced their usual reactions.

Obviously, this does not constitute a clinical trial. Nonetheless, I find this a compelling observation: People like myself who generally experience distinct undesirable reactions to wheat did not experience these reactions with einkorn.

Note, however, that einkorn behaves like a carbohydrate. No different, say, from brown rice or quinoa. However, unlike modern whole wheat flour from Triticum aestivum,  in this little experience there were no immune reactions, no neurologic phenomena, no gastrointestinal distress--just the blood sugar consequences.

While this may not be true for all people consuming einkorn, it suggests that primordial einkorn wheat is quite different from modern conventional wheat for most people.

Comments (6) -

  • Anonymous

    6/23/2010 12:42:43 PM |

    Dr. Davis,

    Interesting. In your opinion, do you think Americans have genetically developed a sensitivity to wheat because of over-consumption? Or, do you think the current variety is just an inferior type?

  • Lindsay

    6/23/2010 1:16:37 PM |

    I do wonder how Spelt (Triticum spelta) might do in this kind of experiment.

  • Anonymous

    6/23/2010 1:31:06 PM |

    It would be interesting to try the same experiments with other early varieties which can actually be purchased retail, like spelt and kamut.

  • Gretchen

    6/23/2010 3:07:13 PM |

    I'd like to see the same experiment without the hour of high-intensity aerobic exercise just beforehand.

  • Cheryl

    6/23/2010 5:18:35 PM |

    wonder what the BG would have been had she done the high impact aerobic workout AFTER injesting the eikhorn bread.

    Carb injestion is suggested for high intensity workouts.

    Also wonder what the impact would be for a person with diabetes T1 or T2.

  • Anonymous

    6/30/2010 7:13:51 PM |

    Another interesting experiment could be to sourdough the eikhorn.  In the old days you couldn't just go to the supermarket and buy yeast. Sourdough is said to be healthier than normal bread because of the fermentation process.

Loading
Do lower heart scan scores grow faster?

Do lower heart scan scores grow faster?

If Mary's heart scan score increases from 2 to 4 in one year, it represents a 100% increase in score.

If Jane's heart scan score increases from 1002 to 1004 over the same period, it represents <1% increase, even though the true growth is the same: 2 points.

This quirk of arithmetic needs to be factored in whenever you and your doctor try to puzzle out the meaning of an increasing CT heart scan score. Lower numbers, particularly those <100, can grow at seemingly much faster rates if viewed by percent per year increase. If no effort is taken to stop the growth in your coronary plaque, then scores of 10, 20, 30, or the like can easily grow 50-100% per year.

In contrast, scores of 1000, 1500, and 2000 tend to grow at "slower" rates of 20% or so per year without corrective efforts, even though the absolute growth may be substantial. (Obviously, this bit of confusion can be best eliminated by reducing your heart scan score, but it doesn't always work out that way.)

If we were all adept at advanced math, we should probably rely on logarithmic measures of plaque increase, rather than percent increase. Or, you can just keep in mind that the rate of plaque growth must always be viewed in the context of the absolute score.
Loading